AMA STEPS Forward®’s Post

The future of health will require coding, coverage and payment that supports digitally enabled care. Discover the results of the AMA’s collaboration with Manatt Health, where we examined commercial payer coverage of #digitalhealth #CPT codes.

The landscape of #healthcare is evolving, and so are the billing practices. A recent study suggests that health systems are increasingly billing for electronic patient-provider messages, turning #evisits into a potential long-term revenue stream. This shift not only signifies adaptation to the #digital age but also highlights potential benefits for hospitals and #healthcareproviders, enhancing financial sustainability and expanding patient access. How will this impact patient care and reshape financial models in healthcare? 🤔 #HealthTech #DigitalHealth #RemotePatientMonitoring #HealthcareInnovation #PatientCare #MedicalTechnology #VirtualCare

🚨 In the face of an unprecedented surge in payer denials, the healthcare industry is at a crossroads. As aggressive payer tactics and a lack of enforcement threaten the foundational mission of patient care and hospital stability, it's time to take a stand. In our recent article published in Becker's Healthcare, we discussed how the escalating crisis of payer denials has pushed healthcare providers to the brink, demanding $20 billion a year just to reclaim what was initially denied. This situation underscores a pressing need for fundamental reforms and a reevaluation of how healthcare institutions handle payer interactions. At CorroHealth, we're not just reacting to denials; we're anticipating and preventing them through strategic, data-driven insights and the robust application of proprietary KPIs like Net Patient Realization™. Our approach empowers clinical leaders to navigate this complex landscape, ensuring that healthcare delivery and financial resilience go hand in hand. 🔗 Read how these challenges are being transformed into opportunities for systemic change, where accountability, foresight, and collaborative innovation lead the charge towards a more stable and sustainable healthcare system. 👉 https://hubs.li/Q02vPmRk0 #PayerDenials #FinancialResilience #DataDrivenHealthcare #ClinicalLeadership #HealthcareInnovation #DenialsManagement #CorroHealth

Experts know that home-based care combats rising healthcare costs with its high-value services. The opportunity remains for more care to flow through these low-cost, high-value providers, and for regulators to remove burdens which constrict access to care. https://hubs.ly/Q02c1Qk30

Humana's 10th annual study sheds light on the positive impact of value-based care on patient experience. Results indicate higher CAHPS survey scores for those in such programs compared to fee-for-service. https://bit.ly/47nLnwP Fierce Healthcare #HealthPlans #payments

Patient experience surveys, like the Consumer Assessment of Healthcare Providers and System (CAHPS) survey, are important tools to understand how patients perceive their healthcare. Although the CAHPS survey provides valuable insight into patient care, some providers and health plans find it difficult to improve CAHPS scores. Medication intelligence provided through an effective AI platform can help health plans take action on patient satisfaction and improve their scores. Learn how Arine’s platform can be a valuable tool to help health plans on their journey for improved Star ratings and CAHPS scores: https://hubs.li/Q026l7Xg0 #PatientExperience

Is there any economic benefit to having a high-performance EMS system? For the vast majority of systems in the US, the answer is a "no". Whether the first pass intubation success of an agency is 75% or 95%, the service will get the same reimbursement. An agency with a 30% cardiac-arrest survival rate gets the same reimbursements as an agency with a 60% survival rate. However, this may eventually change. Medicare is aiming to move to a value-based care model by 2030, which aims to tie health-outcomes to reimbursement rates. Value-based care is important to align system-values (revenue) with patient-values (outcomes). While there is no word as to whether this includes pre-hospital medicine yet, or what it will look like if it does, we are hoping that this may economically incentivize organizations to develop systems that promote high-quality patient care. Learn more about Value Based Care from Medicare: https://lnkd.in/e-mG7X9g.

Healthcare costs are projected to rise 8% for the Group market next year according to a new PwC analysis. As the medical cost trend continues upward, it's increasingly imperative to control healthcare costs while supporting members on the path towards better outcomes. See how The Clinic by Cleveland Clinic's virtual second opinions expand access to high-quality specialty care, generating savings and impact for members with chronic and complex conditions: https://lnkd.in/grGmUx_a #healthcarecosts #specialtycare #virtualsecondopinions

The Alliance for Value-Based Patient Care calls on Congress to further boost incentives and put patients first. The extension of Medicare’s incentive in Congress’ latest spending package is a positive signal that value-based care remains a bipartisan priority amid unyielding fiscal constraints. However, the package cuts the incentive for providers in advanced alternative payment models by nearly half, jeopardizing a decade’s worth of gains in quality and cost savings.   Transforming U.S. healthcare into a higher performing, lower cost system requires consistent incentives from year-to-year that allow providers to invest in people and technology to ➡️Coordinate patient care ➡️Improve patient outcomes ➡️Reduce spending   Read the statement from Alliance spokesperson Soumi Saha, senior vice president, Premier Inc.: https://bit.ly/49FM59P   #Medicare #ValueBasedCare #Congress #APM

Now that we know that outcomes are predominantly about what delivery team members can do in practices, systems, and hospitals, why have our priorities not shifted to changing populations - preferably in the earliest months and years of life when this is most efficient and effective? Trying to change people after 6 or more decades of life influences is difficult and puts more strain on overburdened health care team members. Those delivering the care need the inside out perspective to be understood. They need less to do, more of them to share complexity, more time with each patient or caregiver, and more continuity in specialty, practice, team, and patient. Our designs shape fewer and lesser team members and higher turnover and toxic practice environments. We are hemorrhaging all who deliver health care across doctors, nurses, and other delivery team members. Surveys indicate more health professional students not planning to deliver care at all. This is a critical time to focus on MELTED Away and reverse the 40 years of assumptions that led to these designs.